Cardiologist weighs time with family against saving lives

Star Tribune (Minneapolis) (MCT) - Outside, snow fell silently as the neighborhood slept. Inside, Dr. Shalini Bobra had been up for hours, her Edina, Minn., home buzzing with activity.

Bracing herself for the day with a belt of chai tea, she shook out a handful of Cheerios for her 10-month-old daughter, Anika, while looking for her car keys and coat.

When the family's nanny arrived, Bobra felt a pang of guilt as she handed off the sleepy-eyed infant before rushing to her job as a cardiologist with the Minneapolis Heart Institute. "You feel guilty if you leave, and you feel guilty if you stay," she said.

Every day, millions of women make the same difficult handoff. But for Bobra, balancing family and a career in cardiology is especially tenuous: Spend more time with your child, or perhaps save a life?

Heart disease kills more women than all cancers combined, including breast cancer, and claimed some 460,000 lives last year. Yet only 8 percent of practicing cardiologists are female, according to a recent survey in the Journal of the American College of Cardiology.

Although more women are choosing the pressure-cooker specialty, they continue to face daunting career challenges, and some research indicates that women suffering from heart disease may not be getting appropriate cardiac care as a result.

At Minnesota's largest cardiology groups, the number of women cardiologists is still slim: three out of 46 at the Minneapolis Heart Institute, 21 out of 136 at the Mayo Clinic in Rochester, and seven out of 37 at the St. Paul Heart Clinic.

"Certainly male cardiologists do a great job," Bobra said. "But it's true that many women prefer to see women doctors."

PERSONAL TOLL

Being a cardiologist has been a life-long dream for Bobra. But the profession extracts a high personal price: Women cardiologists are less likely than their male colleagues to marry or have children. That's due in part to the intensity and length of training _ usually six years _ during peak childbearing years, the Journal found.

In addition, two-thirds of practicing women cardiologists said in the survey they have experienced gender discrimination, mostly related to the competing demands of work and family.

Despite that, women in the field report extraordinarily high job satisfaction. "It is very intellectually stimulating," said Dr. Athena Poppas, a cardiologist at Brown University who conducted the survey of 1,110 female cardiologists. "There's a lot of good research, there's satisfaction from taking care of patients, many of them you get to know quite well because you follow them for years, and you can work with your hands, if you want."

Best of all, Poppas said, "A lot of your patients actually get better."

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DETERMINED

You could say cardiology is in Bobra's genes. Her mother, Dr. Veena Gupta, is a cardiologist, and her younger sister, Sheila Gupta, is finishing her residency in New York and plans on pursuing the specialty as well. (Bobra's husband, Shalabh, the apparent rogue in the family, is a radiologist.)

A Wellesley undergrad, Bobra went to medical school at Memorial University in Canada and completed her residency at Westchester Medical Center in New York. She followed that with a cardiology fellowship at Albert Einstein College of Medicine's Montefiore Medical Center in the Bronx, N.Y., a decidedly urban experience the ever-polite Bobra describes as "interesting."

Bobra, now 33, moved to Minnesota more than a year ago because her husband is originally from Plymouth, Mich., and was seven months pregnant when she started at the Minneapolis Heart Institute.

She was attracted to the nationally known practice because of its commitment to research and its large size. "Someone can usually cover for me," she says. "I don't know how women in small practices, in small towns, do it."

Bobra was recruited by a cardiologist at the Heart Institute, Dr. Elizabeth Grey, also an East Coast transplant and a mother of two. The women became fast friends. They discuss work and kids and often grab a quick lunch together.

Bobra's job can have dizzying variety. She treats patients at Abbott Northwestern and at other hospitals outstate; she reads patient diagnostic tests; and she's often invited to give talks about heart disease to the community. At least one weekend a month, she's on 24-hour call at the hospital, which makes parenting duties even more challenging. That doesn't include clinical research or completing requirements to keep her training current.

Bobra usually gets home by 6:30 in the evening, is in bed by 10 p.m., then rises at 4 a.m. Anika is "mostly" sleeping through the night, she said.

The Bobras have lived in their impeccable Edina home for more than a year, but there are still boxes to unpack, and some rooms remain sparsely furnished. "We don't have a dining room set yet," she confessed. "But we recently bought a couch."

Asked if she and her husband spend time together alone, they glanced at each other and laughed. "There's no such thing as a weekend," Bobra said.

Still, Bobra is quick to point out how lucky she is to have a job and a family she loves. She is not one to complain.

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PIONEERS

Bobra and Grey were preceded by a generation of women cardiologists who faced similar, if more extreme, challenges in the traditionally macho field.

Dr. Susan Farkas, a cardiologist at MeritCare Heart Center in Fargo, N.D., and mother of two, is decidedly no-nonsense about her career. The 53-year-old physician _ the lone female cardiologist in North Dakota _ trained in her native Hungary, entranced by the specialty of the heart. She had two children while still in medical school. "I always felt I could fit everything in my life, I never felt I would be overwhelmed or tired," she said. "I strapped on my kids, one on my back and the other in front."

Farkas didn't feel slighted by male colleagues. "I never felt that I needed to prove anything," she said. "I did very well in school, there was never any question that I couldn't do it, even with two kids."

Farkas credits a supportive husband and her parents for pitching in, a common theme among her peers. Unlike many other women, she didn't feel guilty about her choices. "I learned to listen to my body and prioritize. Dirty laundry bothered me less than (it bothered) other people. I don't feel ashamed if I pick up some food rather than cook it. If I need help, I ask for it."

Other women in the specialty decided that doing both was too difficult. Dr. Sharonne Hayes, director of the Women's Heart Clinic at the Mayo Clinic in Rochester, decided early in her career to work part-time, knowing cardiology full time "wasn't conducive to family life," especially since her husband is a busy cardiologist, too. "A full-time cardiologist does not work 40 hours a week," she said. "It's more like 60- to 80-hours."

Now a nationally known spokesperson on women's heart health, Hayes, 49, had her daughter while she was still in cardiology training, and her son five years later. She thought the decision to work part-time could affect her career advancement, but that hasn't proven to be the case _ she's spent the bulk of her career at Mayo.

"Every mother who goes off to work and leaves her children is conflicted," Hayes added. "I feel fortunate that I'm doing something that's meaningful to me, and I hope it helps other people. So in some ways, that makes it easier."

Despite the challenges, Hayes says she encourages young women to pursue cardiology as a career. Often, they ask about her research. Others ask about the prevalence of heart disease among women. But the most pressing questions are: "When did you have kids?" And, "How did you make it work?"

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While growing up in New York, Bobra never contemplated how her cardiologist mother found balance in her life. Mainly she was struck, even at a young age, by her mom's enthusiasm for her job. It was infectious.

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© 2009, Star Tribune (Minneapolis)